Fiber optic sleeve for surgical instruments

ABSTRACT

A disposable fiber optic sleeve for attachment at the forefront of a surgical instrument. The sleeve is an elongated tubular shape and incorporates multiple fiber optic bundles for transmission of visible light to enhance intraocular visualization. Additional bundles of optical fibers may provide for the application of laser beam and video transmission to intraocular tissue. The sleeve is constructed of inexpensive plastic materials and is designed to be disposable after a single or several uses.

This is a continuation of application Ser. No. 08/125,774, filed Sep.24, 1993, now U.S. Pat. No. 5,478,338.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to surgical devices and, more particularly, todevices for effecting the transmission of light for endoillumination,intraocular endoscopy, or laser application to intraocular tissue.

2. Discussion of the Related Art

The most widely accepted prior art means for performing intraocularsurgery in the anterior segment of the eye comprise a variety ofinstruments designed for irrigation, ablation, cutting and removal oftissue. Separate instruments for irrigation, illumination and laserapplication are known, but they have the disadvantage of requiringmultiple surgical openings in the eye and may be cumbersome to operatefor the surgeon. Multiple surgical openings in the eye and multiplesurgical instruments add to the risk of complications and increase thedifficulty of the surgical procedure. Surgical instruments that combinewater infusion, suction and light conducting elements in a single probehave been described, but they have the inherent physical limitationsimposed by side-by-side conducting channels. Another problem that arisesin the use of complex multiple-element surgical instruments is the costand labor of repeated sterilization.

Examples of ophthalmic instruments of the type described arecommercially available from Grieshaber & Co., Inc., 3000 Cabot BoulevardWest, Langhorne, Pa. 19047. These are shown in company brochures underthe title "The Grieshaber Light Source and Family of Accessories".

Recent reports of specific cases in which prior art instruments of thetype described are used may be found in Arch Ophthalmol Vol. 111, July1993: "Neodymium-YAG Laser Phacolysis of the Human Cataractous Lens" andOphthalmology, Vol. 100, Number 7, July 1993: "Experimental EndoscopicGoniotomy". The former describes a performance of Nd-YAG laserphacolysis on a particular patient for the removal of a nuclearsclerotic cataract. The latter report describes the use of an endoscopecoupled to another surgical instrument in experimental surgery onporcine cadaver eyes designed to lead to the use of a tiny endoscopeattached to a goniotomy needle for the treatment of primary infantileglaucoma. Both of these arrangements are subject to the deficienciesdescribed hereinabove.

OBJECTS OF THE INVENTION

The primary object of the present invention is to provide an attachmentfor surgical devices, specifically adaptable for intraocular surgery,that provides illumination, endoendoscopy, and a means for laser beamdelivery. The device is economical in its construction so as to beinexpensively re-sterilized and reused or simply discarded after eachuse because of its low cost. The device comprises a fiber optic sleevewhich is easily and inexpensively fabricated and useful in conjunctionwith a variety of surgical procedures. For purposes of illustration,arrangements of the invention will be discussed in relation to apreferred embodiment for ophthalmic use and with respect to variousconsiderations involved in the recommended utilization of thearrangements disclosed herein. The invention is not so limited, however,and it is entitled to the scope of protection afforded by theaccompanying claims.

Illumination

The vast majority of intraocular surgical procedures involvevisualization by the surgeon through a high-powered microscope usingintense coaxial illumination. It is well-documented that direct andintense microscope illumination may be damaging to the retina; macularedema with corresponding reduction of vision is the primary side effect.As an alternative, focal illumination directed at an oblique angle andin a direction away from the retina can enable the surgeon to reduce theamount of direct microscope light necessary to perform ocular surgery,thereby minimizing potential retinal light toxicity.

A common problem in the present state of the art is that visualizationof the proximal tip of the surgical device is often impeded when blood,scar tissue, or inflammatory debris is present. During normalphacoemulsification of a cataract in the presence of a small pupil, theproximal tip of the surgical device is obscured behind the iris.Consequently, there is a higher risk of inadvertent rupture of the lenscapsule, vitreous prolapse into the anterior chamber and retinalproblems, all of which are associated with visual loss. Use of a fiberoptic sleeve in accordance with the invention permits visualization ofthe anterior portion of the surgical instrument by virtue oftransillumination through the iris leaf or opaque media. Moreover, it isoften difficult for the operating surgeon to judge the depth of cataractor other intraocular structures. Surgical intervention to an excessivedepth can lead to complications resulting in visual loss. Focalillumination at an oblique angle with a fiber optic sleeve of theinvention can enhance the operating surgeon's ability to judge the depthof intraocular structures and thereby lessen the possibility of surgicalmishap.

Endoscopy

Direct visualization of vital intraocular structures during surgery canbe realized with the image-carrying capacity of the fiber optic sleeveof the invention. Intraocular microendoscopy can be utilized to confirmpositioning of haptics of a posterior chamber intraocular lens. Atpresent, the surgeon is not able to visually inspect and confirm thelocation of posterior chamber intraocular lens haptics. Malpositionedhaptics may result in lens decentration subsequent to surgery.Decentration of lens implants causing visual loss or distortionnecessitates corrective surgical procedures. Visualization ofintraocular lens haptics in combination with positioning adjustments atthe time of surgery can prevent intraocular lens decentration.

Laser Application

Finally, the fiber optic sleeve of my invention permits application oflaser illumination for intraocular tissue coagulation and ablation. Thepresent invention provides a means to couple laser energy delivery withsimultaneous illumination and visualization. Lasers capable oftransmission through the fiber optic sleeve include Holmium:YAG (2.1 umwavelength), Thulium:YAG (1.96 um wavelength), Erbium:YAG (2.94 umwavelength), Hydrogen Fluoride (2.7-3.0 um wavelength), DeuteriumFluoride (3.7-4.1 um wavelength), Carbon Monoxide (5.3-5.7 umwavelength), Carbon Dioxide (10.6 um wavelength), Argon Fluoride (193 nmwavelength), Krypton Fluoride (248 nm wavelength), Diode Red (670 nmwavelength), Xenon Chloride (308 nm wavelength), Argon Blue (488 nmwavelength), and Argon Green (514 nm wavelength).

Laser ablation of ciliary body processes responsible for producingexcessive intraocular fluid, and for creation of a drainage fistulathrough the sclera, permits control of elevated intraocular pressure andglaucoma. Laser photocoagulation of ciliary body processes for treatmentof glaucoma used in the present art involves external treatment throughperipheral iridectomies. The effectiveness of this treatment issignificantly limited because only a small number of ciliary processescan be treated. In the presently preferred embodiment, the endolaser andendoscopic capabilities permit treatment of the ciliary processes for atleast 180 degrees, allowing for an enhanced laser therapeutic effect.

Manual methods used for anterior lens capsulotomy have inherentdisadvantages that includes inadvertent radial capsule tears.Significant radial capsule tears are likely to result in complicationssuch as vitreous prolapse or implant subluxation. Such disturbances canreduce or eliminate the visual benefit of an eye operation, or delay thehealing process. Anterior capsulotomy with laser allows for controlledand precision capsulotomy edges unattainable by manual methods.

In addition, laser application through the fiber optic sleeve is usefulas a substitute or adjunct for ultrasonic phacoemulsification incataract surgery.

In summary, from the foregoing discussion it will be appreciated thatthe fiber optic sleeve of the present invention is particularlybeneficial when used with implements for intraocular surgery. It is ofsimple and inexpensive construction so that it may be re-sterilized bygas or readily disposable after a single use. In addition, the fiberoptic sleeve provides an advantage for the anterior segment surgeonbecause it provides focal illumination and capability for simultaneouslaser application.

SUMMARY OF THE INVENTION

In brief, arrangements in accordance with the present invention comprisea fiber optic sleeve device particularly adapted to be installed on aphacoemulsification instrument so as to provide a focal light source atthe point of surgery. The conventional phacoemulsification instrumentfor which the fiber optic sleeve of the present invention is adaptedconsists of a handpiece containing a magneto-strictive ultrasonicmechanism that activates a hollow, 1 mm titanium needle covered with asoft silicone sleeve. The needle is driven by the ultrasonic mechanismto vibrate forty thousand times per second longitudinally in the axis ofthe needle. The mechanical vibration transforms the patient's lens intoan emulsion, hence the name "phacoemulsification". One such instrumentis marketed by Mentor O&O, Inc., 3000 Longwater Drive, Norwell, Mass.02061.

As the cataract is dissected by the high frequency phacoemulsificationprobe, it is sucked into the hollow titanium needle. Since removal ofintraocular fluid must be balanced with the introduction into the eyewith an equivalent amount of fluid, an irrigating solution is passedbetween the silicone sleeve and outer wall of the titanium needle. Thesilicone sleeve presently in use serves only as a conduit to direct flowof saline solution. The present invention involves the incorporation ofa specially designed fiber optic sleeve that substitutes for thepresently used silicone sleeve. Thus, the fiber optic sleeve of thepresent invention provides for the transmission of the irrigatingsolution to the site of the cataract while also transmitting focal lightto the point of surgery.

BRIEF DESCRIPTION OF THE DRAWINGS

A better understanding of the present invention may be realized from aconsideration of the following detailed description, taken inconjunction with the accompanying drawing, in which:

FIG. 1 is a general schematic view showing a human eye in the process ofundergoing a surgical procedure;

FIG. 2 is an enlarged schematic cross-sectional view showing a fiberoptic sleeve and phacoemulsification instrument combination of theinvention as used in the removal of a cataract from a human eye;

FIG. 3 is an enlarged schematic sectional view of the fiber optic sleeveof FIG. 2;

FIG. 3A is a schematic view, partially broken away, of a portion of thefiber optic sleeve of FIG. 3 showing one particular couplingarrangement;

FIG. 3D is a schematic view, partially broken away, of an alternativearrangement to that of FIG. 3A;

FIG. 4 is a schematic sectional view of an alternative embodiment of theinvention;

FIGS. 4A and 4B show alternative termination elements for use with thearrangement of FIG. 4;

FIG 5 is a schematic sectional view of still another embodiment of theinvention;

FIG. 5A is an enlarged schematic view of a portion of the embodiment ofFIG. 5; and

FIG. 5B is an enlarged schematic view in cross section of a wall portionof the embodiment of FIG. 5;

FIG. 6 is an enlarged schematic cross-sectional view showing details ofthe embodiment of FIG. 4.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

FIG. 1 shows a human eye in the process of undergoing a surgicalprocedure using a phacoemulsification instrument 1 of conventional typewith a sleeve 1A and needle 2. The instrument 1 is inserted through ascleral flap eye incision A and into the anterior chamber B.

FIG. 2 schematically represents a similar procedure being performed withthe substitution of a fiber optic sleeve in accordance with the presentinvention. FIG. 2 shows an enlarged cross-sectional view of the eye. Thecataract has been removed by conventional extracapsular surgicaltechnique, including phacoemulsification, and the posterior capsule Cremains intact. The fiber optic sleeve 3 is attached at the forefront ofa phacoemulsification instrument 1. Optical fiber bundles 4 are shownextending from the sleeve 3. For the application disclosed, the fiberoptic sleeve 3 is utilized for the purposes of endoillumination, videotransmission, and application of photoablative laser energy to the parsplicata of the ciliary body for treatment of glaucoma.

FIG. 3 is an enlarged longitudinal schematic cross-sectional view of thepresent invention. The fiber optic sleeve has a proximal (leading) end 5and a distal (trailing) end 6. With continuing reference to FIG. 3, thefiber optic assembly 3 consists of an elongated standard cannula adapter7 at the distal end 6 that is continuous with a frustoconical nipple 8,extending to cap 9, and then to a tapered applicator tip 10. An annularchamfer 11 and adjacent lipped flange 12 on the interior surface of thefrustoconical nipple 8 permit insertion and securing of an internalcoupler in the chamber 13 or for receiving an O-ring 14, which providesa liquid-tight seal when the sleeve is assembled on the surgicalinstrument. It is contemplated that other types of securing means suchas locking rings can be used to secure the fiber optic sleeve member tothe forefront of a surgical instrument. A circumferential lip 27 isprovided at the distal end for facilitating installation of the sleeve 3on a surgical instrument in preparation for use. The entire longitudinallength of the fiber optic sleeve 3 is approximately one inch.

The fiber optic sleeve 3 of the present invention is constructed of softplastic material containing one or multiple fiber optic bundles. A fiberbundle 15 is shown in FIG. 3A and FIG. 3B. Material used in constructionconsists of vinyl plastic or other commercially available non-toxicmedical grade plastic. Fiber optic bundles 15 contained within the bodyof the sleeve are constructed of commercially available quartz orzirconium fluoride optical fibers. The size of the central cylindricalbore 16 can be controlled during the manufacturing process, so that thefiber optic sleeve may be adaptable to a variety of surgicalinstruments. One or two portals 29 at the proximal end of the sleeve canbe constructed at the time of manufacture to allow for flow of fluidbetween the fiber optic sleeve and the surgical instrument contained inits bore. Fluid entry allows maintenance of globe pressure and preventsexcess heating of the laser element.

The cap 9, nipple 8 and cannula adapter 7 are preferably encased byopaque silicone, tetrafluorethylene coating, or polyethylene cladding,which enhances optical transmission and also forms a protective sheath.The extent of cladding can be varied depending on the amount anddirection of light transmission desired; cladding that terminates onemillimeter from the proximal end of the applicator tip 10 would providediffuse illumination, whereas cladding to the most anterior edge of theapplicator tip 10 may be desirable in situations where a more focusedbeam is necessary. The face 18 of the proximal tip 10 is unclad andunencapsulated to provide uninterrupted application of light forillumination, microendoscopy, or laser beam application.

Coupling to standard sources for video, illumination or laser is securedat the distal portion of the fiber optic sleeve 3 by standard methods.Optical fiber couplers are well known in the prior art, for example seeU.S. Pat. No. 4,089,584 of Christopher E. Polczynski. In FIG. 3 arecessed, female receptor well 19 at the distal face of the cannulaadapter 7 serves to connect to an external male fiber optic cable (notshown). Details of alternative embodiments are shown in FIGS. 3A and 3B.The embodiment of FIG. 3A comprises an internally threaded annularfemale well 19A having an accurately machined surface of revolution tointerfit with a corresponding threaded male connector fiber optic source(not shown). The flat base of the receptor well 19A allows for a securefit and good light transmitting connection between the fiber opticbundle from the light source and the optical fibers 15 in the sleeve 3.The number and placement of individual optical fibers arranged inreceptacles in the receptor well 19 can be controlled during themanufacturing process.

Alternatively, the receptacle well of FIG. 3B is shown as a threadlesscone 19B having a gradual internal taper for receiving a similarlytapered, mating end of the fiber optic cable from the light source [toan annular diameter smaller than the connecting fiber optic source]. Inthis arrangement, an external fiber optic cable is precision formed tomate snugly within the receptacle well 19B. In addition, the posteriorend 6 can be attached to a laser catheter assembly by means of aconventional coupler or heat shrink wrap.

FIG. 4 shows a tangential cross-sectional representation of the presentinvention. The fiber optic sleeve 3 consists of individual tracts offiber optic bundles 15 of 500 to 600 micron quartz fibers having a bendradius of 4 centimeters or less that are incorporated within the body ofthe sleeve 3. The fiber optic bundles 15 within the sleeve 3 can bearranged in distinct radially-spaced coherent light conducting portions,or in fiber bundles having spatial fiber distribution. In accordancewith one particular feature of the invention, the tips of the opticalfibers within the bore of the sleeve are recessed slightly for providinga collimated output beam. It is contemplated that a lens such as thelens 28 of FIG. 4A can be fused at the proximal end of the fiber opticbundle for focusing laser energy 30, or at the proximal end of the fiberoptic bundle for illumination 31, or at the proximal end of the fiberoptic bundle for endoscopy 32. Alternatively, an end piece 33 bearing aplurality of lenses 28 for the respective bundles 15 at their respectiveterminations 30, 31 and 32 can be installed at the end face 18 of thesleeve 3. Such a lens may be manufactured with a combination of convex,concave or flat surfaces. In the example of FIG. 4A, a plano-concavelens is shown.

FIG. 5 shows an alternative embodiment of the present inventionconsisting of a sleeve 3' of optically clear flexible plastic 20 encasedon its outer 21 and inner 22 surfaces by a thin layer of siliconecladding or opaque, non-toxic plastic capsule with a low index ofrefraction, or by a reflective coating, such as polytetrafluorethylene,which enhances the optical transmission of the fiber optic sleeve. Inthis embodiment, the fiber optic bundles 15 are omitted because theentire sleeve 3' serves as an optical waveguide as indicated in FIG. 5B.The couplers 19', of which two are shown, are regularly spaced about theperiphery and serve to couple the fiber optic bundles from a lightsource (not shown) into the optically clear plastic 20 for transmissionof light to the tip end 5. Alternatively a diffusing collar may beprovided, interposed between the light cable(s) and the sleeve 3'.

Preferably, the end face at the tip end 5 of the sleeve 3' should bebeveled or angled inwardly so that the light emanating from the end faceis directed at an angle radially inward toward the centerline of theembodiment. This is represented schematically in the enlarged schematicview of FIG. 5A which shows the end of the sleeve 3' encompassing aneedle 4 and having a beveled end surface 30 extending at an angle α toa plane normal to the needle 4. The central axis of the needle 4 isrepresented by the broken line 32. The conical beam of light emanatingfrom the beveled surface 30 is represented by the dashed lines 34, 35.The dashed line 34 intersects the axis line 32 at the same angle α. Theinner surface 22 of the sleeve 3' is spaced from the needle 4 by adimension s.

In practice, the angle α is a function of the dimensions of the needle 4and the sleeve 3'. For a needle 4 having a diameter of 1 mm andprojecting from the end 5 of the sleeve 3' by 2 mm, with sleeve wallthickness equal to 0.5 mm and spacing S also equal to 0.5 mm, the angleα should be approximately 23 degrees. If the spacing S is reduced to0.25 mm, the angle α should be slightly less than 20 degrees. Angle αcan actually be calculated by determining its tangent: i.e., thedistance from the outer surface of the sleeve 3' to the centerline 32divided by the distance from the end 5 to the intersection of the lightcone line 34 with the centerline 32. In such an arrangement, the lightcone illuminates the field of view for approximately 1.5 mm beyond theneedle tip and approximately 0.75 mm of the end of the needle 4.

FIG. 6 illustrates an alternative embodiment of the fiber optic sleeve3" that incorporates multiple groups of fiber optic bundles 15 ofoptically segregated fibers for purposes of illumination 23, laserdelivery 24, and microendoscopy 25 contained within the body of thesleeve. Each group of bundles 15 is positioned within a correspondinghollow tube 26 extending the length of the sleeve 3. Segregated opticalfiber bundle groups are coupled at the distal end to conventionaldelivery systems for illumination, laser delivery and microendoscopy forvideo broadcast. It will be understood that the optical fibers in thebundle for microendoscopy must be maintained in the same orientationthroughout their length in order that the pixel juxtaposition of thedisplay will accurately represent the optical field of view. Opticalsegregation is accomplished by encapsulation of optic fiber bundles byoptically opaque cladding on the inner surfaces of the hollow tubes 26identical to that used on the external and internal surfaces of thesleeve 3' in the embodiment of FIG. 5.

Operation in Use

The operation of the system is as follows:

A light cable, laser cable or video cable (not shown) is connected at areceptacle well 19 situated in the terminal rim 27 of the fiber opticsleeve 3. A fiber optic bundle conducts light between the attachment atthe receptacle well 19, through the wall of the fiber optic sleevecannula 7, cap 8, cap 9 and proximal face of the fiber optic applicatortip 10. Fiber optic bundles 15 terminating at the proximal face of thefiber optic sleeve 3 provide light to illuminate the operative area ofregard, or may provide laser energy for treatment of intraocularstructures. Separate and coherent fiber optic bundles 25 similarlycoursing within the walls of the fiber optic sleeve, provide intraocularendoscopy. Saline fluid to maintain globe pressure enters from thecontained surgical instrument and travels within the hypodermic lumen tobe discharged at the open applicator tip 16 or portals 29 of the fiberoptic sleeve. Operation is the same for illumination using the sleeve 3'of FIG. 5 by coupling the light cable directly to the sleeve 3'.

Although there have been described hereinabove various specificarrangements of a fiber optic sleeve for surgical instruments inaccordance with the invention for the purpose of illustrating the mannerin which the invention may be used to advantage, it will be appreciatedthat the invention is not limited thereto. Accordingly, any and allmodifications, variations or equivalent arrangements which may occur tothose skilled in the art should be considered to be within the scope ofthe invention as defined in the annexed claims.

What is claimed is:
 1. A disposable light transmitting sleeve device, for engagement with a surgical instrument, comprising:a generally tubular sleeve with proximal and distal ends, the sleeve being in the form of an elongate generally tapered hollow shell shaped for attachment to a surgical instrument and formed of soft, flexible, non-toxic medical grade plastic material bounded by inner and outer wall surfaces; and means for controlling and directing optical radiation internally between said wall surfaces and substantially along the sleeve from one end to the other.
 2. A sleeve as defined in claim 1 wherein said means comprise thin coatings of silicone cladding along said inner and outer wall surfaces.
 3. A sleeve as defined in claim 2 wherein said coatings consist of polytetrafluorethylene to provide optical radiation reflectivity.
 4. A sleeve as defined in claim 2 having a terminal surface at the proximal end of the sleeve which is selectively shaped to direct transmitted optical radiation to the vicinity of the end of the associated surgical instrument.
 5. A sleeve as defined in claim 4 wherein said terminal surface is beveled at a selected angle α relative to a plane normal to the central axis of the sleeve and associated surgical instrument.
 6. A sleeve as defined in claim 2 further including means for coupling optical radiation to the plastic material between said inner and outer wall surface coatings, said coupling means being situated at the distal end of said sleeve and adapted to engage cable means coupled to a light source.
 7. A sleeve as defined in claim 1 wherein the material of said sleeve has an index of refraction which exceeds the index of refraction of the optical radiation controlling and directing means.
 8. A sleeve as defined in claim 1 wherein the optical radiation controlling and directing means comprise a plurality of optical fibers embedded within the plastic material and extending substantially throughout the length of the sleeve from one end to the other.
 9. A sleeve as defined in claim 8 wherein the optical fibers are arranged in optically segregated fiber optic bundle groups for utilization in endolaser application in conjunction with endoillumination and intraocular microendoscopy, respectively.
 10. A sleeve as defined in claim 9 wherein each of said optically segregated fiber optical bundle groups is positioned within a corresponding hollow tube extending the length of the sleeve, the inner surface of each of said hollow tubes being coated with optically opaque cladding to provide total internal reflection of optical radiation within the tube.
 11. A sleeve as defined in claim 9 wherein each of the fiber optic bundle groups terminates in a fused lens at the proximal end thereof for focusing optical radiation transmitted along the bundle group.
 12. A sleeve as defined in claim 9, further including an end piece bearing a plurality of lenses fused to the ends of the fiber optic bundle groups for focusing optical radiation transmitted thereby.
 13. A sleeve as defined in claim 9 further including means for coupling the fiber optic bundle groups respectively to conventional delivery sources for illumination, laser delivery or video imaging.
 14. A sleeve as defined in claim 8 further including an adapter member for coupling the optical fibers to an external source of optical radiation.
 15. A sleeve as defined in claim 14 in which said adapter member includes a cylindrical, threaded female receptor well precisely machined to interfit with an external male cable connector for receiving optical radiation from an external source.
 16. A sleeve as defined in claim 14 wherein said adapter member includes a gradually tapered unthreaded receptor well for frictional engagement with a connector for receiving optical radiation from an external source.
 17. A disposable light transmitting sleeve device for use with a surgical instrument for endoscopy and treatment of intracorporeal structures with optical radiation, the instrument defining proximal and distal ends, comprising:a sleeve formed of flexible, non-toxic medical grade plastic material bounded by inner and outer wall surfaces and having a hollow interior which is shaped and sized to fit the proximal end of the surgical instrument on which the sleeve is mounted, the sleeve defining a distal end located adjacent the proximal end of the surgical instrument and a proximal end remote from said distal end, the distal end being larger in diameter than the proximal end; coupling means for removably mounting the sleeve on the proximal end of the surgical instrument; and, light transmitting means mounted with the plastic material of the sleeve and extending from the distal end to the proximal end in order to transmit optical radiation the length of the sleeve within the plastic material between the inner and outer wall surfaces.
 18. The device of claim 17, wherein the light transmitting means comprises at least one fiber optic bundle formed of a plurality of optical fibers arranged in an annular configuration and having an orientation parallel to the sleeve along its central axis.
 19. The device of claim 18 comprising a plurality of fiber optic bundles, each being formed of a plurality of optical fibers, a first one of said bundles being adapted for endoillumination, a second one of said bundles being adapted for endoscopy, and a third one of said bundles being adapted for endolaser application.
 20. The device of claim 19 further including a coupling means at the distal end of the sleeve for coupling said fiber optic bundles to a mating portion of the surgical instrument.
 21. The device of claim 20 further including means installed within the plastic material of the sleeve at said distal end for coupling a fiber optic bundle to a mating element on said surgical instrument.
 22. The device of claim 21 wherein said coupling means comprise an internally threaded annular female well sized to interfit with a threaded male connector of said surgical instrument.
 23. The device of claim 18, wherein the proximal end of the sleeve is sloped inwardly to provide an inner bevel which is closest to the central axis of the sleeve.
 24. The device of claim 23, wherein the optical fibers are angled inwardly toward the central axis of the sleeve in the vicinity of the proximal end of the sleeve.
 25. The device of claim 18 further including a lens mounted at the proximal end of the sleeve and coupled to terminate an adjacent fiber optic bundle for focusing optical radiation which is transmitted by said bundle. 